| NPI | 1093976276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04312) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007293) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2016-08-24 |